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Chronic Pain Lecture at Clarkson University for Fibromyalgia Awareness Day

The Potsdam Fibromyalgia Support Group will celebrate Fibromyalgia Awareness Day with a lecture on chronic pain, “Why is Chronic Pain So Difficult to Treat?,” on Sunday, May 15, at 7 p.m. on the first floor of Clarkson University’s Clarkson Hall, 59 Main St. in Potsdam. A reception with refreshments and information on various aspects of chronic pain will begin at 6:30.

Leslie N. Russek, a faculty member in the Clarkson University Department of Physical Therapy and a physical therapist at Canton-Potsdam Hospital, will deliver the lecture.

Through her research, teaching and clinical practice, Russek has more than 20 years of experience with the unique features of chronic pain. She runs the Potsdam Fibromyalgia Support Group and has given a number of community and professional lectures on fibromyalgia, headaches, and chronic pain.

For more information about this lecture or about the Fibromyalgia Support Group, contact the Canton-Potsdam Hospital Physical Therapy Department at 315-261-5460.

About Chronic PainBy Leslie N. Russek, PT, DPT, Ph.D., OCS

Fibromyalgia is one type of chronic pain. Chronic pain affects about 70-150 million Americans, accounting for up to 20% of all primary care visits in the U.S. Chronic pain affects up to 35% of adults and 25% of children –more people than diabetes, heart disease, and cancer combined. Medical costs for chronic pain are estimated at $50-100 billion/year.

With a medical system that can perform so many ‘miracle cures,’ why is chronic pain still so difficult to treat? It turns out that the physiology of chronic pain is quite different from that of acute pain. While acute pain serves as a warning system to alert us that tissue damage is occurring, chronic pain does not always correlate to tissue damage.

Consequently, medical testing to identify damaged structures can come up empty-handed, to the great frustration of both patient and physician. Chronic pain becomes a disorder of the nervous system, where the peripheral or central nervous system becomes hypersensitive – a condition called ‘central sensitization.’

Stress, anxiety and depression only make the nervous system more hypersensitive, thus amplifying the pain further. Chronic pain is like The Boy Who Cried Wolf: it reports pain even when there is no wolf (i.e., tissue damage). It is therefore considered ‘maladaptive’ pain – that is, it no longer serves to protect us from tissue damage. But chronic pain is just as real as acute pain – the nervous system still registers real pain.

Chronic pain results in high levels of disability when people are unable to perform normal life roles such as worker, parent, spouse or community member. Disability is amplified by a downward spiral of decreased activity: pain causes decreased activity, decreased activity causes deconditioning with weakness and reduced endurance, weakness and reduced endurance decrease function, decreased function leads to further decreased activity and increased pain. And the spiral goes around, getting worse and worse.

To break this cycle, it is important for people with chronic pain to remain active, in spite of the pain. Exercise can avoid or reverse all of these changes – decreasing pain, increasing strength, endurance and function. The challenge is often finding a form of exercise that a person with chronic pain is able to do, starting easy, and progressing gradually. It can take a bit of faith to stick with an exercise program that takes a few weeks to show benefits – just like some medications that require several weeks before they show a benefit.

It is also important to realize that the pain associated with chronic pain does not always indicate damaged tissues the way acute pain does. So, while pain in an acute condition is a warning telling us to back off so we do not injure ourselves further, pain in a chronic condition does not have the same meaning – it is “crying wolf” and reporting an injury that might not exist. Again, it is critical to remember that chronic pain is just as real as acute pain, it is just that the problem is likely to be in the nervous system rather than the muscles or joints.

Treatments that work for acute pain often do not work for chronic pain. Medications to decrease inflammation will not work if there is no inflammation. Surgeries to fix damaged structures cannot succeed if there are no damaged structures to fix. Instead, treatments need to focus on fixing the problems in the neural tissues and on minimizing disability.

Medications for chronic pain are often those that directly affect the central nervous system – for example, anti-seizure or anti-depressant drugs. Such medications can calm down the hypersensitive nervous system so that it does not relay pain signals so easily. Exercise causes the release of endorphins, the chemicals that cause a runner’s high, which work the same way as some opiate medications.

Since stress, anxiety and negative thinking amplify pain, strategies to minimize stress and negative thinking calm down the nervous system and can also decrease chronic pain. For example, relaxation training, meditation, and soothing forms of exercise like yoga or tai chi can help. Aerobic exercise – even just walking – also helps calm the nervous system.

Cognitive behavioral therapy helps teach people to avoid negative thinking, beliefs and behaviors that amplify pain. Focusing on functional activities, making sure you do some things that you enjoy, pacing yourself so you do not overdo it, can also help.